Cyclic vomiting syndrome: Difference between revisions
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==Background== | ==Background== <!--T:1--> | ||
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*Recurrent episodes of [[Special:MyLanguage/vomiting|vomiting]], otherwise normal health in between | *Recurrent episodes of [[Special:MyLanguage/vomiting|vomiting]], otherwise normal health in between | ||
*32% of patients disabled by illness by time of diagnosis<ref>Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.</ref> | *32% of patients disabled by illness by time of diagnosis<ref>Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.</ref> | ||
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==Clinical Features== | ==Clinical Features== <!--T:3--> | ||
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*Pediatric diagnostic criteria<ref>Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.</ref> | *Pediatric diagnostic criteria<ref>Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.</ref> | ||
**At least 5 episodes or minimum of 3 over 6 mo | **At least 5 episodes or minimum of 3 over 6 mo | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:5--> | ||
</translate> | </translate> | ||
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==Evaluation== | ==Evaluation== <!--T:6--> | ||
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*Clinical diagnosis of exclusion | *Clinical diagnosis of exclusion | ||
*Evaluate for alternate etiologies | *Evaluate for alternate etiologies | ||
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==Management== | ==Management== <!--T:8--> | ||
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*Avoid triggers | *Avoid triggers | ||
**Many patients have known triggers, such as diet, psychological stressors, sleep deprivation, cannabis, or infection. | **Many patients have known triggers, such as diet, psychological stressors, sleep deprivation, cannabis, or infection. | ||
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==Disposition== | ==Disposition== <!--T:10--> | ||
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*If symptoms can be controlled, may discharge | *If symptoms can be controlled, may discharge | ||
*For intractable vomiting unable to be controlled with medications, admit | *For intractable vomiting unable to be controlled with medications, admit | ||
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==See Also== | ==See Also== <!--T:12--> | ||
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*[[Special:MyLanguage/Cannabinoid hyperemesis syndrome|Cannabinoid hyperemesis syndrome]] | *[[Special:MyLanguage/Cannabinoid hyperemesis syndrome|Cannabinoid hyperemesis syndrome]] | ||
==External Links== | ==External Links== <!--T:14--> | ||
==References== | ==References== <!--T:15--> | ||
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<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
</translate> | </translate> | ||
Latest revision as of 12:55, 14 January 2026
Background
- Recurrent episodes of vomiting, otherwise normal health in between
- 32% of patients disabled by illness by time of diagnosis[1]
- Pathophysiology not well understood
- Average age at onset ~21yo
- Females slightly more affected than males
- Marijuana use is risk factor
Clinical Features
- Pediatric diagnostic criteria[2]
- At least 5 episodes or minimum of 3 over 6 mo
- Nausea/vomitingepisodes lasting 1hr-10d, with 1 week in between
- Stereotypical pattern and symptoms
- Return to baseline health in between
- Symptoms not due to another condition
- Adult – Rome III criteria [3]
- Stereotypical episodes of vomiting with acute onset lasting less than 1 week.
- At least 3 episodes per year.
- No nausea/vomiting between episodes.
- Symptoms not due to another cause
- Symptoms usually begin in early morning or upon waking
- Prodrome of nausea--> vomiting
- Episodes peak/decline over ~8h
- Nausea typically not relieved by vomiting
- +/-
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
Evaluation
- Clinical diagnosis of exclusion
- Evaluate for alternate etiologies
- Assess for dehydration, electrolyte abnormalities if clinically warranted
Management
- Avoid triggers
- Many patients have known triggers, such as diet, psychological stressors, sleep deprivation, cannabis, or infection.
- May be on medications typically used for migraine prophylaxis
- Abortive antiemetics therapy
- Ondansetron- works better with benzos or diphenhydramine
- Promethazine, prochlorperazine
- Triptans (e.g. sumatriptan)
- Supportive therapy
Disposition
- If symptoms can be controlled, may discharge
- For intractable vomiting unable to be controlled with medications, admit
See Also
External Links
References
- ↑ Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.
- ↑ Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.
- ↑ Venkatasubramani N, Venkatesan T, Li BUK. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology. September 2007. 31:21-34.